Miles's blog

If you want an illustration of the fruitlessness of fighting the war on drugs through interdiction, read two recent New York Times articles on the abuse of prescription drugs.

The first article described a dramatic increase in the deaths from prescription drug overdoses in New Mexico in the past ten years.  As you might expect, most of the drugs were painkillers like oxycodone.  Most were prescribed lawfully, at least at first.  Many prescription drug addicts went on to harder street drugs like heroin, when the effects of the medication grew insufficient.  One drug counselor said all of the heroin addicts he treats started first abused prescription drugs.

Yesterday, the Times published an article which was perhaps more chilling.  It presented a picture of high school students relying upon prescription medications designed to help those with attention deficit disorder to gain focus while taking tests.  According to the article, a large percentage of high-achieving students are using this medication, whether their own or pills they secure from other students.  The pills seem to work amazingly well, according to the students interviewed, allowing users to raise grades and enhance test scores.  The drugs are frighteningly easy to procure.  Some students merely told psychiatrists the stories they knew would result in prescriptions; other purchased the drugs from those with prescriptions.

Obviously, prescription drug abuse has been around as long as there have been prescription drugs, but today’s culture makes it far more prevalent.  Doctors, perhaps afraid of being sued, wield their prescription pads like gunslingers, ready to prescribe with the smallest provocation.  ADD (and ADHD), unheard of a generation ago, now rules the schools.  Every kid caught staring out the window or procrastinating doing his homework is whisked away to a pill-dispensing doctor. 

I do not mean to denigrate ADD diagnoses and treatment.  The affliction is real and the medication helps.  I do mean to bring up the point that the billions of dollars we pay for Columbian military troops to attack coca growers and for Mexican police officers to go after millionaire drug lords do not address these problems.  Prescription drug abuse is a growing problem because prescription drug use has increased so dramatically.  New medications, aging populations, and diminished social stigma to drug usage in general has brought America into an age where huge numbers of people feel drug usage is an acceptable response to what they view as the stress in their lives.  Whether the drugs are legitimately-procured or not has grown increasingly irrelevant.

Many of the high school students quoted in the article reeled off a list of stressors, from grades to extracurricular activities to worries about college admissions.  (They may have answered these questions while texting from their cars.)  Most of these kids seem to come from privileged homes with parents who have tried to fill every need while making their children happy.  The kids say they need good grades to satisfy their parents. 

How many of these parents do you think use prescription medication themselves, and I don’t mean for a thyroid condition?  In what percentage of homes is marijuana either openly used or tacitly allowed?  After all, it was the parents who brought their child to the psychiatrist to diagnose ADD in the first place.

We have come to see modern medicine as having the capacity to solve every problem.  Cancer is no longer a death sentence, AIDS seems to be a treatable disease, people rise up out of wheelchairs.  Most of us, including me, think a medical doctor and a prescription will solve everything.  If we are in pain, there is a ladder of pain medication which will take it away.  All of this serves to make prescription medication part of our daily lives.  As such it is readily available, socially acceptable, and in large measure unregulated.  (Putting marijuana into this category, as many states have already done, plays into this problem.)  This makes prescription drug abuse very, very difficult to prevent.

One can weigh, I suppose the harm caused by prescription drugs against the evils of street drugs of abuse and decide that cocaine, methamphetamines, and heroin are the greater society ills.  This might justify using resources to reduce their availability.  But I question the effectiveness of that policy.  Street drugs of abuse are still present while prescription abuse rises.  Better, in my mind, to attack drug abuse at the source. 

Every article I read carries quotes from experts in the treatment community.  Generally they describe how difficult it is to rehabilitate someone from drug use.  If only more of the treatment resources were devoted to prevention.  Ways moght be found to keep legitimate users of medication from developing addictions, and high schoolers could be convinced drugs, prescription or otherwise, are not the answers to their problems.  (Unfortunately, right now the answer seems to be that drugs ARE the answer.  They get into a better college and use the drugs to keep up good grades there.  I assume they will continue to use the drugs when they get jobs.  I have no idea what the effect of long-term use of these drugs will be.)

I realize that modern America views drug usage as a benign circumstance.  I recently went to an excellent play where one of the key scenes involved a grandmother and her grown grandson bonding over some marijuana.  The pot loosened their conversation, allowing each to see the other in new and more comfortable ways.  The audience enjoyed this scene, laughing loudly as it became apparent that grandma was stoned.  Drugs, including prescription medication, marijuana, and alcohol, have become ingrained in our society.  We need to work to prevent abuse and control their use.  Burning fields of poppies in Afghanistan will do little to solve the drug problem.